Choledochoduodenostomy as an Alternative to Choledochojejunostomy in Liver Transplantation

Excerpt

The optimal technique for reconstruction of the bile duct has been the subject of much debate over the relatively short history of liver transplantation. In early liver transplants the gallbladder was used as a conduit, but this practice was replaced by duct-to-duct anastomoses with or without a T-tube. The ability to explore the biliary transplant anastomosis by endoscopic means has been one of the key drivers for the routine use of duct-to-duct anastomoses. It is not always advisable or possible to use the recipient duct: for example, in primary sclerosing cholangitis or when ducts have been damaged by previous surgery or pancreatic disease. In such situations a biliary enteric anastomosis has usually been employed. …